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Ebola and Marburg Virus Disease Epidemics: Preparedness, Alert, Control and Evaluation

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EBOLA STRATEGY Ebola and Marburg virus disease epidemics: preparedness, alert, control and evaluation August 2014 © World Health Organization 2014. All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. WHO/HSE/PED/CED/2014.05 Contents Acknowledgements ............................................................................................................ 5 List of abbreviations and acronyms ................................................................................... 6 Chapter 1 – Introduction .................................................................................................... 7 1.1 Purpose of the document and target audience ..................................................................... 8 1.2 Background .......................................................................................................................... 8 Chapter 2 – General strategy .......................................................................................... 14 2.1 Before: pre-epidemic phase ................................................................................................ 15 2.2 Alert: suspected Ebola or Marburg ..................................................................................... 16 2.3 During: epidemic phase ...................................................................................................... 16 2.4 After: Post-epidemic phase ................................................................................................. 16 2.5 Use of the document .......................................................................................................... 17 Chapter 3 – Before: What should be done in the pre-epidemic phase?........................... 20 3.1 Establishment of a viral haemorrhagic fever surveillance system ....................................... 21 3.2 Infection control precautions in health-care settings ........................................................... 22 3.3 Health promotion programme ............................................................................................. 23 3.4 Collaborate with mine health services (Marburg) and wildlife health services (Ebola) ......... 23 3.5 Pre-alert: What should be done if the specimen taken from animals tests positive for Ebola or Marburg? ....................................................................................................................... 24 Chapter 4 – Alert: What should be done when Ebola or Marburg is suspected? ............. 25 4.1 Investigating suspected Ebola or Marburg ......................................................................... 26 4.2 Obtaining laboratory results ............................................................................................... 29 4.3 Taking a decision on the basis of laboratory results and the outcome of the investigation . 29 Chapter 5 – During: What should be done once the epidemic is confirmed? .................. 30 5.1 Marburg and/or Ebola epidemic control strategy ................................................................ 31 5.2 Coordination and resource mobilization ............................................................................. 32 5.3 Coordination and resource mobilization ............................................................................. 35 5.4 Behavioural and social interventions .................................................................................. 38 5.5 Behavioural and social interventions .................................................................................. 43 5.6 Clinical case management ................................................................................................. 44 5.7 Psychological management ............................................................................................... 49 5.8 Research projects and ethical issues ................................................................................. 51 5.9 Logistics and safety ........................................................................................................... 55 5.10 Environmental management ............................................................................................. 56 Ebola and Marburg virus disease epidemics: preparedness, alert, control and evaluation 2 Chapter 6 – After: What should be done once the epidemic is over? .............................. 59 6.1 Declare the end of the epidemic ...................................................................................... 60 6.2 Resume the activities of the pre-epidemic phase ............................................................. 60 6.3 Medical follow-up of survivors .......................................................................................... 60 6.4 Monitoring of recovering patients and social problems..................................................... 60 6.5 Produce the end-of-epidemic report ................................................................................. 61 6.6 Keep records on the epidemic ......................................................................................... 61 6.7 Evaluate the management of the epidemic ...................................................................... 61 Chapter 7 – Annexes ....................................................................................................... 64 General information about Ebola and Marburg virus diseases Annex 1. WHO Ebola haemorrhagic fever fact-sheet (no. 103) ................................................ 65 Annex 2. WHO Marburg haemorrhagic fever fact-sheet (November 2012) ............................... 65 Surveillance and epidemiology Annex 3a. Standard case definition of viral hemorrhagic fever for routine surveillance ............. 66 Annex 3b. Standard case definition of viral haemorrhagic fever for community-based surveillance .............................................................................................................................. 66 Annex 3c. Examples of Marburg or Ebola virus disease case definitions that may be used during the outbreak .................................................................................................................. 67 Annex 4. Contact tracing: Standard definition of Ebola or Marburg contacts ............................. 69 Laboratory Annex 6. Guidelines for the collection of clinical specimens during field investigation of outbreaks ................................................................................................................................. 73 Annex 7. Guidance on regulations for the Transport of Infectious Substances 2011-2012 ....... 73 Annex 8. List of laboratories and WHO Collaborating Centres for the diagnosis of Ebola or Marburg VHF ............................................................................................................................ 73 Social and behavioural interventions and communications Annex 9. Outbreak Communication. Best practices for communicating with the public during an outbreak ................................................................................................................................... 75 Annex 10. Communication for Behavioural Impact (COMBI): A toolkit for behavioural and social communication in outbreak response. ...................................................................................... 75 Annex 11. COMBI Toolkit: Field Workbook for COMBI planning steps in outbreak response. .. 75 Annex 12. Behavioural and Social interventions: a checklist for conducting a rapid situation analysis during suspect Ebola and Marburg events .................................................................. 76 Annex 13. Contribution of medical anthropology to Ebola and Marburg viral haemorrhagic fever outbreak control........................................................................................................................ 78 Clinical management of patients Annex 14. Hospitalized patients' charter (May 2013) ................................................................ 84 Annex 18. Transmission risk reduction of filoviruses in home-care settings .............................. 85 Annex 19. Protocol for the reintegration of returning patients into their families and their community ................................................................................................................................ 87 Psychosocial management Annex 20. Mental health in emergencies .................................................................................. 88 Ebola and Marburg virus disease epidemics: preparedness, alert, control and evaluation 3 Annex 21. IASC Guidelines
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